(3) ORGANIZATION OF BRONCHIOLAR AND PNEUMONIC PROCESSES.
The processes described for the preceding group which involve not only the alveoli, but also the bronchi and the bronchioles, were predicted from the extensive hyalinization of these structures—a characteristic change in the more fulminating and acute phases of the disease. Likewise, it can be predicted that where death does not terminate the process such lesions will be followed by organization, which, by converting the exudate into scar, will produce deformities and offer serious mechanical interference with the ingress and egress of alveolar air and similar interference with the flow of blood through the pulmonary circulation (82).
FIG. XXIV. AUTOPSY NO. 92. AN ALMOST PURE HEMORRHAGIC ALVEOLAR EXUDATE. COMPARE FIGURES [VI], [XXV], AND [XXVI].
FIG. XXVI. AUTOPSY NO. 103. THE LARGER ILLUSTRATION OF AN HEMORRHAGIC ALVEOLAR EXUDATE IS ELABORATED BY TWO HIGHER POWER DRAWINGS. THESE SHOW (1) AN ANEURSYMAL DILATATION OF A CAPILLARY IN THE ALVEOLAR WALL AND (2a) A RUPTURE OF THE CAPILLARY WALL WITH THE ESCAPE OF RED BLOOD CELLS INTO THE ALVEOLUS; (2b) NECROSIS WITH EARLY THROMBOSIS OF THE CAPILLARY IN THE ALVEOLAR WALL.
It is probable that chronic processes, not sufficiently severe to terminate fatally in a few weeks or months, may occur, but few examples of that kind have been observed. A total of twelve cases of our series in which organization of the bronchiolar (47), or alveolar exudate (156) was found, include three of the lobar, three of the pseudolobar, two of the lobular, and four of the peribronchial types. Such a differentiation, it will be understood, is purely arbitrary. The majority of the cases show, not only a reparative process, but also a continuance of the acute change, and, indeed, both gross and microscopic pictures of the lung may be complicated. It will be impossible to give an inclusive description of these changes, and therefore a few of the most diverse and characteristic will be presented in the form of case abstracts.
Autopsy No. 140.
A white female, aged 19 years, entered the New Haven Hospital after five days of fever, prostration, and cough. She was moderately cyanotic and dyspnœic, but examination of the lungs was negative except for a few râles at the right base. She was delivered of a six-months’ fœtus two days later. On the eleventh day of her illness, definite signs of consolidation had developed in the midback on both sides and spread gradually to include the left base and all of the right back to the level of the 4th dorsal spine. The temperature varied irregularly between 100°F. and 105°F. The pulse followed the temperature, but averaged 102 per minute, while the respirations remained about 40 per minute.
The white blood count on admission was 5,800, but rose gradually to 28,320 cells per cubic millimeter, with 90% of polymorphonuclear leucocytes. The patient died on the twenty-second day of the disease.